CMS is Trying to Make Our Lives Easier

Another new rule this week comes from CMS in improving efficiency of data sharing and prior authorization requests. 

Another new rule came out of CMS this week, focused on reducing friction between payers, providers and most importantly, patients. The new rule claims to increase data sharing measures through coordinated care and interoperability: getting data systems and electronic servers to seamlessly share data and information. The “CMS Interoperability and Prior Authorization Rule” makes an effort to aggregate patient data and to keep the patient updated in real time as to when things are being approved by their physicians and insurers. 

Breaking this down, let’s imagine the way things are now in comparison to what this new rule would change in the future. Say you go to a new doctor, switching from an old practice, and you have to fill out all the health history forms, bring you medical records if you’re lucky enough to have them, and then rehash basically your medical life story with your new doctor. Well with this new rule, you wouldn’t need to do all of that. The doctor’s office would have your documents and data before you show up for your appointment. 

Secondarily, imagine yourself needing a new prescription that has just been authorized by your new doctor. Because this new practice is not communicating with your insurance company yet, you are left for several days just waiting to see if your insurance will cover the meds and what funny hoops you’ll have to jump through to get the medications. In this new world, you wouldn’t need prior authorization because your data is being shared accurately across systems. That way you can just go to the pharmacy! 

This all sounds fantastic but the one snag is that those electronic systems need to be created. Electronic health records (EHRs) have been around for about 10 years in various forms, but one system often doesn’t “speak” to another. The new mandate requires the creation of APIs or application programming interfaces that would provide better access to your data, while getting rid of the prior authorization issue. The APIs would work with the EHR systems to streamline access to your data, no matter where you go. 

The Pandemic will teach us lessons for years to come. This Rule is a takeaway from 2020 manifested in the improvement of coordinated care and reduction of the burden on providers so they can focus their limited attention on providing the best care possible.

Source: https://healthpayerintelligence.com/news/cms-rule-targets-prior-authorization-with-interoperability